This question comes up all to often and I wanted to send a quick message out addressing it. Many physicians find it overly burdensome and annoying to bother their patients with co-pays, deductibles and co-insurance. However, if you do not collect all of the above, you are in fact committing insurance fraud. If this concept sounds severe, its because the repercussions may be severe. A $5-$20 co-pay may not seem like a lot of money when patients leave an office when the visit will be reimbursed for several hundreds of dollars by a third party payor, but amounts that should have been collected add up over time.

The New York State Office of the Commissioner has started paying particular attention to medical practices all across the state and investigating such situations. So, I strongly recommend that if you own or work for a practice that does not attempt to collect co-pays, deductibles or co-insurance that you correct this policy. $5 out of your patient's pocket at the time of visit may save you countless in legal fees, penalties and refunds.

When collecting of attempting to collect co-pays, the Department of Insurance expects you to make a good faith effort, which means speaking to your patient population about paying at the time of service, sending out notices of late payments and possibly sending off late bills to collection. There is no bright line rule of what is required for you to do to collect monies owed, but the bright line exceptions of when you do not have to pursue a patient is when the patient is indigent (known to be and can prove that they cannot pay) or when services are a professional courtesy.

Should you desire any additional information on this topic, please do not hesitate to ask.


For additional information on this topic, contact Jennifer Kirschenbaum at (516)-747-6700 ext. 302 or at


Copyright © 2012 by Kirschenbaum & Kirschenbaum, P.C.
All Rights Reserved. This email is provided for news and information purposes only and does not constitute legal advice or an invitation to an attorney-client relationship. While every effort has been made to ensure the accuracy of the information contained herein, Kirschenbaum & Kirschenbaum PC does not guarantee such accuracy and cannot be held liable for any errors in, any reliance upon this, or losses caused by the information. Under New York’s Code of Professional Responsibility, this material may constitute attorney advertising. Prior results do not guarantee a similar outcome.